PLEASE PRINT OFF SUMMARY FORM BELOW & MAIL IT & YOUR MEMBERSHIP FEE TO:
HANDICAPPED FRIENDS PEN PAL CLUB
P.O. BOX 623 -- Dept. WEB
COTTAGE GROVE, OREGON 97424-0027
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HANDICAPPED FRIENDS PEN PAL CLUB SUMMARY FORM
NAME _____________________________________________
PHONE #____________________________(for office use only)
ADDRESS___________________________________________
CITY_______________________________________________
STATE_________________ZIP__________________________
MALE___________FEMALE_____________AGE_____________
BIRTHDATE____________________RACE_________________
HEIGHT________________WEIGHT(opitional)_____________
TYPE OF DISABILITY__________________________________
INTERESTS & HOBBIES
(1)________________________________________________
(2)________________________________________________
(3)________________________________________________
(4)________________________________________________
(5)________________________________________________
(6)________________________________________________
Single_________Married________Separated______________
Divorced____________Widowed______________
Type of PEN PAL preferred:
MEN_____________WOMEN___________BOTH____________
Will you write Prisoners? (Yes)____________(No)__________
E-mail Address_______________________________________
PLEASE ADD ANY ADDITIONAL INFORMATION YOU WANT SHARED.
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I understand HANDICAPPED FRIENDS PEN PAL CLUB cannot assume responsibility beyond the publication of the summaries & delivery of responses. Keeping in mind that the members have not been investigated, I hereby release HANDICAPPED FRIENDS PEN PAL CLUB from any/all liability for events resulting from my correspondence with other members.
DATE__________YOUR SIGNATURE______________________
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MEMBERSHIP FEE is: $16 for 6 months or $28 for 1 year. OVERSEAS: . ADD $4/$7 US FUNDS ONLY! Checks or Money Orders payable to: HANDICAPPED FRIENDS. Send to: HANDICAPPED FRIENDS PEN PAL CLUB, P.O. BOX 623, COTTAGE GROVE, OR 97424-0027
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